Patrick D. Guinan, MD, MPH

University of Illinois, Chicago, United States

This is an open-ended question and, for that reason, difficult to answer. We agree that life is a natural good and should not be willfully terminated (self-defense and a just war being exceptions). But in many instances life can be prolonged, almost indefinitely, by such means as parenteral enterostomal gastrostomy (PEG), dialysis, defibrillators, and left ventricular assist devices.1 With more of these life prolonging options being used, the question, “must life be prolonged?” becomes ethically critical.

Obviously the answer is “yes” and “no.” The Catholic Church’s position is that each individual patient must decide for himself [Ethical and Religious Directives (ERD) 57 and 59].2 At conception God creates the human person. This person during the formative years attains the knowledge of right and wrong and realizes that his eternity will be judged by his earthly behavior. For the Christian, then, death is transformed from a curse into a blessing. In death, God calls man to himself. The Catechism states, “The Christian can experience a desire for death like St. Paul’s, ‘My desire is to depart and be with Christ.’” 3,4

In the Catholic tradition, death is a neutral event, neither good nor bad. But for most humans death is generally seen in a negative light, often associated with aging, suffering, pain, and disabilities. Although death is often a release from suffering, the dying process is feared and humans want to be in control of it.

Using artificial feeding as an example, is it ethical to prolong life by a PEG—an artificial feeding tube surgically implanted into the stomach? In general, if a patient is not dying, it is often regarded as customary nursing care. But such feeding is not necessarily mandated in terminal conditions such as end-stage cancer. Additionally, if a patient feels that this form of treatment has becomes excessively burdensome, they can stop eating and refuse artificial nutrition and hydration (ANH).

Does the Catholic Church morally require that a patient consent to a PEG placement? The ERD suggest that burdensome treatment is not required and that this determination should be made by the patient. Although others may feel that a PEG is required, there is ample literature to suggest that PEG-assisted feeding does not necessarily prolong life and may even increase morbidity and mortality.5

However, some argue that any hastening of death is unethical, and some individuals suggest that hospices, which discontinue certain medications and life support systems in terminal situations, breach an ethical line. Using this argument, any “do not resuscitate” (DNR) order would be immoral because many arrested hearts can be restarted. However, these resuscitative efforts are often grim, largely unsuccessful ordeals that most families should not witness. Thus, is consent to a DNR order an indirect suicide because the patient is certain to die when he might have been revived?2

Returning then to the original question, “must life be always be prolonged?” we conclude that life can be prolonged, but need not be. Extraordinary means are not mandated in all instances, and each person needs to decide for himself what he regards as burdensome.

Notes

  1. Fang J. The rise of machines: left ventricular assist device on permanent therapy for advanced heart failure. N Engl J Med. 2009 Nov 17;361:2282-2285. doi: 10.1056/NEJMe0910394.
  2. United States Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services. Washington, DC: USCCB; 1995.
  3. Phil. 1:23 (New American Bible)
  4. John Paul II. Catechism of the Catholic Church. New Hope, KY: New Hope Publications; 1994. P. 263.
  5. Li I. Feeding tubes in patients with severe dementia. Am Fam Physician. 2002 Apr 15;65(8):1605-1611.

 


PATRICK D. GUINAN, MD, MPH is a 1962 graduate of Marquette University Medical School. The author went on to obtain a graduate degree in Public Health from Columbia University in 1965. He is presently a Clinical Associate Professor in the Department of Urology in the College of Medicine at the University of Illinois at Chicago and serves as Chairman of the Board of the Hektoen Institute of Medicine.